Search tips
Search criteria 


Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. 2007 July; 92(7): 652.
PMCID: PMC2083755

Awareness of guidelines on pleural infection

Guidelines for the management of pleural infection in children were published in 2005 as a supplement in Thorax1 with an accompanying editorial.2 They are also available on the British Thoracic Society (BTS) website (www.brit‐ Additionally, the guidelines were endorsed by the Royal College of Paediatrics and Child Health (RCPCH) after scrutiny by their Quality and Practice Committee. RCPCH published a guideline review in the Education and Practice Edition of Archives of Disease in Childhood,3 mailed their guideline appraisal to all College members, and placed it on their website ( The guidelines were also presented at the BTS Winter Meeting (2004) and annual RCPCH meeting (2005). They have been widely disseminated and the aim of this study was to ascertain, 1 year later, how aware general paediatric and respiratory trainees were of the guidelines.

All tertiary paediatric respiratory units in the UK were selected (from the 11th BTS Directory of training posts and services in adult and paediatric respiratory medicine, 2006), excluding our own centre. An alphabetical list of all district general hospitals (DGHs) was taken from the Guardian NHS and Social Services directory 2004‐05 and every 10th hospital was selected. A questionnaire was devised and the on‐call general or respiratory paediatric middle grade trainee was telephoned (on weekday afternoons) and asked to take part. In a yes/no/do not know format, we ascertained whether the department used any local guidelines, and whether the trainee was aware, familiar with or unaware of the BTS guidelines.

All 105 trainees agreed to take part: 77 in DGHs and 28 in tertiary respiratory centres. All had been in the post at least 1 month apart from one person who had only been there for 1 day. Cases were managed in 5/77 DGHs and 23/28 specialist centres. In the 28 centres managing cases, 18/28 (64%) had their own local guidelines for empyema management, six (21%) did not and in four (14%) the trainees were unsure. Comparison of guideline awareness between trainees in DGHs and specialist centres is shown in fig 11.

figure ac115485.f1
Figure 1 Familiarity of middle grade paediatric trainees with the BTS guidelines on management of pleural infection in children, in 28 respiratory specialist centres (dark grey) and 77 district general hospitals (light grey).

Awareness is less than optimal among specialist, and particularly general paediatric, trainees. We simply accepted their answers; there was no “testing” of their supposed familiarity with the guidelines, so if anything, our figures may be an overestimate. Although better than the DGHs, the tertiary centres can not afford to be complacent, as in 25% of them the on‐call trainee was unaware of the BTS guidelines. This study only surveyed middle grade trainees, and it may be that all the on‐call consultants were very familiar with the guidelines and, once informed by the trainee about the case, would institute appropriate management. Worryingly, out of the five DGHs that managed cases themselves, in two of them there were no local guidelines, and in the same two centres the trainee was unaware of the national guidelines. In conclusion, writing the pleural infection guidelines was a useful process as it clarified many issues and pointed to where evidence was required. However, it is disappointing that despite extensive attempts to disseminate the guidelines, a large number of middle grade trainees were unaware they even existed, let alone were familiar with their contents.


Competing interests: None.


1. Balfour‐Lynn I M, Abrahamson E, Cohen G. et al BTS guidelines for the management of pleural infection in children. Thorax 2005. 60(Suppl 1)i1–i21.i21 [PMC free article] [PubMed]
2. Balfour‐Lynn I M. Some consensus but little evidence: guidelines on management of pleural infection in children. Thorax 2005. 6094–96.96 [PMC free article] [PubMed]
3. Baumer J H. Parapneumonic effusion and empyema. Arch Dis Child Ed Pract 2005. 90ep21–ep24.ep24

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group